Determinants of Surgical Site Infections Following Pancreatoduodenectomy

Barreto, Savio George; Singh, Manish Kumar; Sharma, Sunil; Chaudhary, Adarsh

doi:10.1007/s00268-015-3115-4

Cited by 28 publications

(30 citation statements)

References 32 publications

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“…Various risk factors for SSI have been reported in recent studies, which are shown in Table 6. Many studies have demonstrated that preoperative biliary drainage [2,7,8,16,17,36,38] and pancreatic fistula [8,10,38] are independent risk factors for SSI, which is consistent with the present study. Previous studies [8,30,36] have reported that a high BMI is a risk factor for SSI, which is consistent with another study in the literature showing that overweight and obesity increase the risk of SSI in many types of surgery [39].…”

Section: Discussionsupporting

confidence: 93%

“…However, the morbidity rate remains high, particularly regarding SSI, which is one of the most common problems after PD. The incidence of SSI after PD varies from 12 to 51% [7,8,[15][16][17]. Many factors contribute to SSI, including multiple enteric anastomoses, extensive physiologic changes, blood loss, and a long operative time [17].…”

Section: Discussionmentioning

confidence: 99%

“…The factors identified in previous studies as risk factors for SSI after PD include preoperative biliary drainage [2,7], pancreatic fistula [8], a high body mass index (BMI) [8], diabetes mellitus [7], blood transfusion [9], malnutrition, and a low serum albumin level [10][11][12]. As previous studies have revealed varying results, the primary aim of the present study was to identify the factors associated with SSI after PD, and the secondary aim was to identify adverse outcomes related to SSI after PD.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of surgical site infection after pancreaticoduodenectomy

et al. 2020

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Background: Surgical site infection (SSI) is one of the most common complications after pancreaticoduodenectomy (PD). Thus, it is beneficial to preoperatively identify patients at high risk of developing SSI. The primary aim of the present study was to identify the factors associated with SSI after PD, and the secondary aim was to identify the adverse outcomes associated with the occurrence of SSI. Methods: A single-centre retrospective study was conducted. All 280 patients who underwent PD at our institution from January 2008 to December 2018 were enrolled. Demographic and perioperative data were reviewed, and the potential risk factors for developing SSI and the adverse outcomes related to SSI were analysed. Results: A total of 90 patients (32%) developed SSI. Fifty-one patients developed incisional SSI, and 39 developed organ/space SSI. Multivariate logistic analysis revealed that the significant risk factors for developing incisional SSI were preoperative biliary drainage (odds ratio, 3.04; 95% confidence interval, 1.36-6.79; p < 0.05) and postoperative pancreatic fistula (odds ratio, 2.78; 95% confidence interval, 1.43-5.38; p < 0.05), and the risk factors for developing organ/space SSI were preoperative cholangitis (odds ratio, 10.07; 95% confidence interval, 2.31-49.75; p < 0.05) and pancreatic fistula (odds ratio, 6.531; 95% confidence interval, 2.30-18.51; p < 0.05). Enterococcus spp., Escherichia coli and Klebsiella pneumoniae were the common bacterial pathogens that caused preoperative cholangitis as well as SSI after PD. The patients in the SSI group had a longer hospital stay and a higher rate of delayed gastric emptying than patients in the non-SSI group. Conclusions: The presence of postoperative pancreatic fistula was a significant risk factor for both incisional and organ/space SSI. Any efforts to reduce postoperative pancreatic fistula would decrease the incidence of incisional SSI as well as organ/space SSI after pancreaticoduodenectomy. Preoperative biliary drainage should be performed in selected patients to reduce the incidence of incisional SSI. Minimizing the occurrence of preoperative cholangitis would decrease the incidence of developing organ/space SSI.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of surgical site infection after pancreaticoduodenectomy

et al. 2020

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“…However, this is associated with significant harm, including a 4 per cent risk of pancreatitis, haemorrhage and bowel perforation. Biliary colonization following ERCP has been reported to be as high as 27 per cent, with a resultant impact on surgical‐site infections after pylorus‐preserving pancreaticoduodenectomy (PPPD).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the clinical and economic impact of delays to surgery in patients with periampullary cancer

et al. 2019

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Background Early treatment is the only potential cure for periampullary cancer. The pathway to surgery is complex and involves multiple procedures across local and specialist hospitals. The aim of this study was to analyse variability within this pathway, and its impact on cost and outcomes. Methods Patients undergoing surgery for periampullary cancer (2011–2016) were identified retrospectively and their pathway to surgery was analysed. Patients who had early surgery (shortest quartile, Q1) were compared with those having late surgery (longest quartile, Q4). Results A total of 483 patients were included in the study, with 121 and 124 patients in Q1 and Q4 respectively. The median time from initial CT to surgery was 21 days for Q1 versus 112 days for Q4 (P < 0·001). Diagnostic delays were common in Q4; these patients required significantly more investigations than those in Q1 (endoscopic ultrasonography (EUS): 74·2 versus 18·2 per cent respectively, P < 0·001; MRI: 33·6 versus 20·6 per cent, P = 0·036). The median time to diagnostic EUS was 13 days in Q1 versus 59 days in Q4 (P < 0·001). Some 42·1 per cent of jaundiced patients in Q1 underwent preoperative biliary drainage, compared with all patients in Q4. There were significantly more unplanned admissions and associated longer duration of hospital stay per patient and costs in Q4 than in Q1 (median: 8 versus 3 days respectively; €5652 versus €2088; both P < 0·001). There was a higher likelihood of potentially curative surgery in Q1 (82·6 per cent versus 66·9 per cent in Q4; P = 0·005). Conclusion There is wide variation across the entire pathway, suggesting that multiple strategies are required to enable early surgery. Defining an effective pathway by anticipating the need for investigations and avoiding biliary drainage reduces unplanned admissions and costs and increases resection rates.

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“…More importantly, postoperative wound infection delays adjuvant chemotherapy in patients with pancreatic cancer and doubles the risk of chemotherapy omission . Potential causative factors include malnutrition, preoperative biliary drainage, and surgery‐related variables such as main pancreatic duct diameter, POPF, and postoperative hemorrhage . The Surgical Care Improvement Project (SCIP) was created by the Centers of Medicare and Medicaid Services to decrease preventable SSIs .…”

Section: Discussionmentioning

confidence: 99%